Medicaid Work Requirements Fifteen Medicaid beneficiaries in Kentucky recently filed suit against the state over its decision to add work requirements for many of the state’s Medicaid recipients. The case is important because at least nine more states are hoping to add similar Medicaid work requirements for some beneficiaries. The decision in the Kentucky case,…

As the first year of President Donald Trump’s administration winds down, he is experiencing the limitations of that office. For example, the GOP-controlled Congress has been unable to produce a bill to repeal-and-replace bill for the Affordable Care Act, despite Trump’s promise he would sign such a bill without question. In response, Trump has taken…

Gun Violence and Mental Health: When the anchor at XYZ Network comes on with “Breaking News” and an announcement that “The latest mass shooting has claimed the lives of XXX people,” it’s clear that the commentary has evolved from one of shock and awe to a kind of inevitability, such as: After all, we’ve “only”…

Models for Value-Based Reimbursement The future of national medical policy may be uncertain, but one thing that is not likely to change is the trend toward value-based contracting in health care. Value-based reimbursement is a bipartisan or “purple” issue, and ironically some of the earliest models were designed under a Republican administration. Republican zeal to…

Opioid Epidemic President Trump has formally declared the opioid epidemic a public health emergency. Drug overdose deaths are now the leading cause of injury death in the United States. [1] In 2010, opiates obtained by prescription were involved in 16,651 overdose deaths (compared with 3,036 heroin-related overdose deaths).[2] While the percentage of heroin-related deaths may have increased…

Considering the $3 trillion behemoth that is the American healthcare system, what the Medicare program paid for telehealth last year is microscopic: $28.7 million. However, that’s up 28 percent from what Medicare paid out in 2015. Total telehealth claims also rose by a third last year, to nearly 500,000 in total. Given major providers…

The efforts in the GOP-controlled Congress to repeal and replace the Affordable Care Act are currently in a state of semi-limbo. Factions in the Senate have coalesced among more conservative and more moderate Republicans. The former believe the Better Care Reconciliation Act does not go far enough and requires more funding reductions to Medicaid and…

ACHA: Under the revised American Health Care Act, states would have the right to waive the Affordable Care Act’s essential health benefits as of 2020. ACHA, round two. After weeks of negotiation between the Freedom Caucus led by Rep. Mark Meadows and Republican moderates led by Representative Tom MacArthur, the Meadows-MacArthur amendment to the…

Medicaid/Medicare; What Could Change in 2017 With Medicaid/Medicare entitlements up for grabs, Dr. Jon Burroughs explains some of the options ‘on the table’ for consideration in the near future. It’s been challenging to predict the near-term futures of the Medicaid and Medicare programs, given the dramatic shift in control of the federal government…

Now that Rep. Tom Price has been confirmed for Health and Human Services (HHS) Secretary, he can halt some of the agency’s mandatory programs, such as the Comprehensive Joint Replacement (CJR) model. However, value-based models will likely remain part of the national strategy moving forward since they are promoted by payers, private insurers, and Medicare.

As the industry spins through a cycle of payment experimentation, providers assume more risk for outcomes and collaboration between health plans, physicians, and hospitals becomes increasingly important.

If, as suspected, states are granted more flexibility to operate their Medicaid programs, methodologies that emphasize population health are likely safest. Under the seven Center for Medicare and Medicaid Innovation (CMMI) categories, healthcare organizations can find attractive options around areas that best exemplify their care models.

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